Current and Optimal Practices in Childhood Asthma Monitoring Among Multiple International Stakeholders
Authors: Nikolaos G. Papadopoulos, Alexander G. Mathioudakis, Adnan Custovic, Antoine Deschildre, Wanda Phipatanakul, Gary Wong, Paraskevi Xepapadaki, Ioana Agache, Stefania Arasi, Zeinab Awad Awad El-Sayed, Leonard Bacharier, Matteo Bonini, Jose A Castro-Rodriguez, Zhimin Chen, Michael Clausen, Timothy Craig, Zuzana Diamant, Francine M Ducharme, Philippe Eigenmann, Wojciech Feleszko, Vincezo Fierro, Alessandro Fiocchi, Luis Garcia-Marcos, James E Gern, Anne Goh, René Maximiliano Gómez, Maia Gotua, Eckard Hamelmann, Gunilla Hedlin, Elham M Hossny, Zhanat Ispayeva, Tuomas Jartti, Miloš Jeseňák, Omer Kalayci, Alan Kaplan, Jon Konradsen, Piotr Kuna, Susanne Lau, Peter Le Souef, Robert F Lemanske, Mika J Makela, Paolo M Matricardi, Oleksandr Mazulov, Michael Miligkos, Mário Morais-Almeida, Clare Murray, Karthik Nagaraju, Antonio Nieto Garcia, Zoltan Novak, Ruby Pawankar, Marielle Pijenburg, Helena Pite, Paulo MC Pitrez, Petr Pohunek, David Price, Alfred Priftanji, Valeria Ramiconi, Daniela Rivero Yeverino, Graham C Roberts, Aziz Sheikh, Kun-Ling Shen, Zsolt Szepfalusi, Ioanna Tsiligianni, Mirjana Turkalj, Steve Turner, Tetiana Umanets, Arunas Valiulis, Susanne Vijveberg, Jiu-Yao Wang, Ran Wang, Tonya Winders, Dong Keon Yon, Osman M Yusuf, Heather J Zar
Journal: JAMA Network Open (2023)

Importance Childhood asthma control largely depends on rigorous and regular monitoring. Although various clinical parameters, biomarkers, and patient-reported outcomes are helpful for monitoring purposes, there is no consensus on the minimum and/or optimal set of parameters and their relative priority. Objective To assess actual and perceived optimal childhood asthma monitoring practices used globally. Design, Setting, and Participants This international, multistakeholder survey study surveyed health care professionals and clinical academics with a professional interest in and exposure to childhood asthma between April 12 and September 3, 2021, to test for differences between the frequency that different techniques are actually used in practice vs optimal practice, between-group differences, and differences across medical settings and country economies. Main Outcomes and Measures Outcomes were frequency of duration of asthma monitoring visits as well as actual and perceived optimal use and importance of monitoring tools and domains. Results A total of 1319 participants with expertise in childhood asthma from 88 countries completed the survey. Participants included 1228 health care professionals with a balanced distribution across different care settings (305 [22.7%] primary care, 401 [29.9%] secondary, and 522 [38.9%] tertiary care) and 91 researchers. Children with mild to moderate asthma attended regular monitoring visits at a median (IQR) of 5.0 (2.5-8.0) months, with visits lasting a median (IQR) of 25 (15-25) minutes, whereas severe asthma required more frequent visits (median [IQR], 2.5 [1.0-2.5] months; median [IQR] duration, 25 [25-35] minutes). Monitoring of symptoms and control, adherence, comorbidities, lung function, medication adverse effects, and allergy were considered to be very high or high priority by more than 75% of the respondents. Different patterns emerged when assessing differences between actual and perceived optimal use of monitoring tools. For some tools, current and optimal practices did not differ much (eg, spirometry), whereas in others, there was considerable space for improvement (eg, standardized control and adherence tests). The largest gap was observed for between-visit monitoring with electronic trackers, apps, and smart devices. Differences across country economies, care settings, and medical specialties were modest. Conclusions and Relevance These survey results suggest that pediatric asthma monitoring is performed generally homogeneously worldwide, in most cases following evidence-based standards. Wider use of standardized instruments and the intensification of continuous between-visit monitoring, supported by electronic devices, is needed for further improvement of disease outcomes. The results of this survey, in conjunction with the available evidence base, can inform recommendations toward further optimization.